Predicting neurosensory disabilities at two years of age in a national cohort of extremely premature infants

• Published in: Early human development 2010-09, Vol.86 (9), p.581-586
• Main Authors: Leversen, Katrine Tyborg, Sommerfelt, Kristian, Rønnestad, Arild, Kaaresen, Per Ivar, Farstad, Theresa, Skranes, Janne, Støen, Ragnhild, Elgen, Irene Bircow, Rettedal, Siren, Eide, Geir Egil, Irgens, Lorentz M, Markestad, Trond
• Format: Article
• Language: English
• Subjects: Advanced Basic Science; Biological and medical sciences; Cerebral Palsy - epidemiology; Child, Preschool; Developmental follow-up; Embryology: invertebrates and vertebrates. Teratology; Extremely low birth weight; Extremely preterm infant; Fundamental and applied biological sciences. Psychology; Gestational Age; Humans; Infant, Newborn; Infant, Premature - physiology; Logistic Models; Models, Statistical; Neonatal and Perinatal Medicine; Neurologic outcome; Norway - epidemiology; Odds Ratio; Predictive Value of Tests; Prospective Studies; Retinopathy of Prematurity - epidemiology; Sensation Disorders - epidemiology; Sensory outcome
• ISSN: 0378-3782; 1872-6232
• DOI: 10.1016/j.earlhumdev.2010.07.009

Abstract Background Extreme prematurity carries a high risk of neurosensory disability. Aims Examine which information obtained pre-, peri- and postnatally may be predictive of neurosensory disabilities at 2 years of age. Study design Prospective observational study of all infants born in Norway in 1999 and 2000 with gestational age (GA) 22–27 completed weeks or birth weight (BW) of 500–999 g. Outcome measures Incidence of neurosensory disabilities. Results Of 373 surviving children, 30 (8%) had major neurosensory disabilities (26 CP, 6 blind, 3 deaf), and a further 46 (12%) had minor visual or hearing disabilities. The rate of major neurosensory disabilities was 19 of 99 (19%) for children with GA 23–25 vs. 8 of 189 (4%) for GA 26–27 weeks (p < 0.001). In a multivariable model, only morbidities detected in the neonatal intensive care unit (NICU) were associated with major neurosensory disabilities; adjusted odds ratios (95% confidence intervals) were 68.6 (18.7, 252.2) for major abnormalities on cerebral ultrasound, 6.8 (1.7, 27.4) for retinopathy of prematurity (ROP) grade > 2, 3.2 (1.0, 9.7) for ROP grade 1–2, 6.5 (1.9, 22.3) for prolonged use (≥ 21 days) of steroid treatment for lung disease and 3.1 (1.0, 9.4) for clinical chorioamnionitis. The visual outcome was strongly related to the degree of ROP (p < 0.001), and all who had a normal hearing screen in the NICU had normal hearing at 2 years. Conclusion NICU morbidities, rather than GA or intrauterine growth are the significant predictors of major neurosensory disabilities among extreme prematurity surviving to discharge from the NICU.